414004998-1-9-2025-05-CC-MTSO-DCRQDH-20250109110447

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004998
Report Date: 01/09/2025
Date Signed: 01/09/2025 11:04:55 AM

Document Has Been Signed on 01/09/2025 11:04 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	WANG, ZHONGLIN		FACILITY NUMBER:	414004998
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 6	CENSUS: 5	DATE:	01/09/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:35 AM
MET WITH:	Zhonglin Wang		TIME VISIT/ INSPECTION COMPLETED:	11:20 AM

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On January 09, 2025 at approximately 8:35am, Licensing Program Analysts (LPAs) Tso and Krenn conducted an unannounced required annual and a case management – initiated visit to the Family Child Care Home listed above. The LPAs were granted entry by the Licensee, Zhonglin Wang. LPAs explained the purposes of the visit. Present during LPAs’ visit included licensee, licensee’s son, a helper, and 5 enrolled children (3 infants and 2 preschool age).The license is operating within capacity limits and ratio during LPA's visit.

Licensee lives in the home. The adult living in the home have criminal record clearance on file. The hours of operation are Monday through Friday 8:00am to 6:00pm. The DAY CARE AREAS are Living Room, Kitchen, Bedroom #1, and Bathroom and backyard. The OFF LIMIT AREAS are bedroom #2, unit #434, garage, side yard and partial of front yard. Off-limit areas are properly barricaded with child safety gates and/or closed doors.

On October 28, 2024, the licensee submitted an application to increase the capacity up to 14. LPAs’ annual inspection also included this case management inspection.

The LPAs and the licensee both performed inspection of the daycare facility to look for any potential health and safety hazards. Toys and equipment that are suitable for children of the proper age range are provided at the daycare. The facility has sufficient lighting and ventilation, and it is free of any defects or conditions that put children at risk. The facility is equipped with a first aid kit that is completely loaded with everything that is required for the treatment of injuries. The daycare facility is equipped with a smoke detector, a carbon monoxide detector, and a fire extinguisher that is always ready for use. Every garbage can and power outlet has been covered. Products for cleaning and washing, detergents, and any other materials that could put children in danger are stored out of the children’s reach. The LPAs did not find any walkers, bouncers, or other comparable objects during today’s inspection. According to the licensee, there are reportedly no firearms or other weapons on the premises. The LPAs found that the facility did not have any bodies of water.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WANG, ZHONGLIN	FACILITY NUMBER: 414004998
	VISIT DATE: 01/09/2025

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The LPAs observed that the facility had posted all the required forms, including the facility license, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The Licensee is aware that smoking is not permitted in a family childcare facility.

Bathroom for children's use was observed to be in proper working condition. LPAs did not observe any hazardous materials to be accessible to children. Entire backyard is fully enclosed and fenced. The outdoor area is equipped with a variety of toys and materials. There is a play structure in the backyard that was observed to be in good condition. Flooring in backyard includes artificial grass that was observed to be clean.
LPAs reviewed five children’s records. Children’s files have a record of emergency identification information on file. Licensee's Pediatric First Aid/CPR is current and will expire 02/2025. LPAs reminded the licensee that the facility should have at least a person with current Pediatric First Aid/CPR training certificate. Emergency drills are properly logged and maintained. Last emergency drill was conducted 08/07/2024. Licensee has licensing documentation properly posted and available for review.

LPAs reminded licensee about Mandated Reporter training available www.mandatedreporterca.com. Licensee was reminded Mandated Reporter training must be renewed every 2 years and all staff whom directly work with children must complete training.

Licensee was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WANG, ZHONGLIN	FACILITY NUMBER: 414004998
	VISIT DATE: 01/09/2025

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Zhonglin Wang, confirmed that there are no Registered Sex Offenders living in the facility.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WANG, ZHONGLIN	FACILITY NUMBER: 414004998
	VISIT DATE: 01/09/2025

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For the case management of application for increase capacity to 14, the licensee has obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the licensee understands that, once licensed, they can operate with a maximum capacity of 12 children.

Parental notification is required if the licensee provides care for a 13th and 14th child who is of school age.

The County San Mateo Fire Department issued a fire clearance for the home on 11/06/2024, as necessary for a Large Family Child Care Home.

Prior to recommended for increase capacity up to 14, application must complete the following for review:

- Attending an Informal Office Meeting.

There were no deficiencies cited at this time under CCR, Title 22, Div. 12, Chapter 3. A copy of today’s report was given to the licensee.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Zhonglin Wang.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC809 (FAS) - (06/04)

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